From the Guidelines
Ulcerations at the urethral meatus are most commonly caused by sexually transmitted infections, with gonorrhea and chlamydia being significant contributors, as highlighted in the 2024 European Association of Urology guidelines on urological infections 1.
Causes of Urethral Meatus Ulceration
The causes can be broadly categorized into infectious and non-infectious etiologies. Infectious causes include:
- Sexually transmitted infections such as gonorrhea, chlamydia, herpes simplex virus, syphilis, and chancroid, which can lead to inflammation and subsequent ulceration 1.
- Other infections like Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis can also cause urethritis, potentially leading to ulceration at the urethral meatus.
Non-infectious causes include:
- Trauma from catheterization or other instrumentation, which can directly damage the urethral meatus.
- Chemical irritation from soaps, spermicides, or other substances that come into contact with the urethral area.
- Certain dermatological conditions like lichen sclerosus or balanitis xerotica obliterans, which can affect the skin around the urethral meatus.
- Autoimmune conditions such as Stevens-Johnson syndrome, which can affect mucosal surfaces, including the urethral meatus.
- Malignancies, such as squamous cell carcinoma, which can manifest as persistent ulcerations.
Diagnosis and Treatment
Diagnosis of the underlying cause of ulceration at the urethral meatus is crucial for appropriate treatment. This may involve physical examination, laboratory testing, including nucleic acid amplification tests for sexually transmitted infections, and possibly biopsy for suspected malignancies. Treatment depends on the identified cause and may include antimicrobials for infections, corticosteroids for inflammatory conditions, and surgical intervention for malignancies or certain cases of trauma. Given the potential for severe complications, including infection spread, stricture formation, and impact on quality of life, any persistent or recurrent ulceration should be promptly evaluated by a healthcare provider. The most recent guidelines, such as those from the European Association of Urology 1, emphasize the importance of timely and appropriate management of urethral infections to prevent long-term sequelae.
From the Research
Causes of Ulceration at the Urethral Meatus
- Ulceration at the urethral meatus can be caused by various factors, including sexually transmitted infections (STIs) such as gonorrhea, which is caused by Neisseria gonorrhoeae 2, 3, 4.
- Gonorrhea can lead to complications such as urethritis, which may cause ulceration at the urethral meatus 3.
- Other STIs, such as herpes simplex virus, can also cause genital ulcers, including those at the urethral meatus 5.
- The presence of a urethral discharge or other symptoms of urethritis may indicate an underlying STI, which can increase the risk of ulceration at the urethral meatus 3.
- In some cases, ulceration at the urethral meatus may be a symptom of a more serious condition, such as disseminated gonococcal infection (DGI), which can occur when Neisseria gonorrhoeae infects the bloodstream 4.
Risk Factors
- Engaging in unprotected sexual intercourse or having multiple sexual partners can increase the risk of acquiring an STI, which may lead to ulceration at the urethral meatus 2, 3, 6.
- Failure to complete treatment for an STI or reinfection can also increase the risk of complications, including ulceration at the urethral meatus 2.
- The presence of other medical conditions, such as HIV/AIDS, can increase the risk of acquiring an STI and developing complications, including ulceration at the urethral meatus 6, 5.